What Is Periodontal Disease

Periodontal disease is a low grade, chronic infection of the soft (gum) and hard (bone) tissue around teeth. It is caused by plaque, a bacterial biofilm that develops on the teeth. If left untreated, it can result in inflammation, bone loss, recession, endodontic infection (root canal), poor esthetics, sensitivity, abscesses, pain and tooth loss. Untreated periodontal disease also contributes to the severity of other systemic inflammatory diseases such as diabetes and cardiovascular disease.

Causes of Periodontal Disease:

The primary etiology of periodontal disease is plaque, a bacterial biofilm that begins forming on the teeth shortly after brushing. The extent and severity of disease depends highly on individual genetics, the type of bacteria present in the mouth, plaque control (oral hygiene - brushing and flossing) and smoking.

In short, periodontal disease is caused by bad genes (genetics), bad bugs (bacteria) and bad habits (poor oral hygiene, smoking). Combining two or more of these (ex. poor oral hygiene and pathogenic bacteria) can result in severe destruction of the periodontal tissues.

However, being diagnosed with periodontal disease does not necessarily mean you have poor oral hygiene. Some people have good oral hygiene, but minimal amounts of plaque cause severe destruction, while others have poor oral hygiene and have no destruction. In fact, recent NHANES study revealed that almost half (47.2%) of the U.S. adult population (30 years and older) has periodontitis. Certainly all these people do not have poor brushing and flossing habits. What is important is to understand your individual risk and strive for excellent plaque control to minimize disease.

To take the American Academy of Periodontology risk assessment test, click here.

Gum Disease Stages: From Gingivitis to Periodontitis:

Gingivitis: Inflammation of the gums. Signs may include red bulbous gums and bleeding upon brushing/flossing and/or mastication.

Periodontitis: Following gingivitis, periodontitis may occur. This is associated with loss of hard (bone) and/or soft (tissue) attachment around the teeth. Periodontitis can range from mild to severe. Typically there is minimal to no pain associated with periodontitis, although destruction is occurring around the teeth and inflammation is present. As bone loss progresses, pockets develop between the teeth and the gum. As these pockets become deeper, they become non-cleansable and more anaerobic, resulting in the inability to remove plaque and more pathogenic bacteria residing at the site. Due to this, it is imperative that a professional treatment be performed, as you cannot reach these sites to effectively remove plaque and stop the disease process on your own.

Symptoms of Periodontitis to Watch For:

Periodontitis often progresses silently, making symptom awareness critical for timely intervention. Recognizing changes early significantly improves treatment outcomes. Symptoms typically intensify as the disease advances.

Early Stage Indicators

These signs commonly appear during gingivitis or initial periodontitis. Do not dismiss them as "normal" brushing sensitivity:

Bleeding gums when brushing or flossing
Red, swollen, or tender gum tissue
Persistent bad breath or lingering bad taste unrelieved by brushing
Early gum recession (gums appearing to pull back slightly from teeth)

Advanced Stage Warning Signs

These symptoms indicate moderate to severe periodontitis requiring prompt professional care:

Pronounced gum recession making teeth appear noticeably longer
Loose, shifting, or separating teeth
Visible pus between teeth and gums
Changes in bite alignment or how teeth fit together
Deep pockets forming between teeth and gums (detected during dental exams)

Note: Gum recession and bad breath may occur across stages but worsen progressively. Even one symptom warrants evaluation.

Can you have periodontitis without pain?

Yes. Periodontitis is frequently painless, especially during early and moderate stages. Many patients remain unaware of active infection until significant bone or tissue damage has occurred. This silent progression is why regular periodontal screenings are essential, particularly if you have risk factors like smoking, diabetes, or family history of gum disease. Never wait for pain to seek evaluation. Early detection preserves your gum health and tooth stability.

Diagnosis of Periodontal Disease:

Periodontal disease is diagnosed using radiographic and clinical analysis. Radiographs are an important part of diagnosis and aid in determining the amount of bone destruction, as well as pathology associated with disease process. Clinically, tissue characteristics, purulence (pus), bleeding and probing depths are used to determine the severity of disease. A "probe" is similar to a ruler, with millimeter markings. It is inserted between the tooth and gum and dropped as far as the tissue will allow and the "depth" is recorded. In health, when bone levels are intact around teeth, probing depths are 2-3mm, which is essentially the thickness of tissue around the teeth. When bone loss has occurred around teeth, it allows the probe to be inserted deeper, resulting in a deeper reading. More simply, deeper readings equal worse disease. Probing depths of 4mm and up indicate there is periodontal disease present, whether it be simple gingivitis or destructive periodontitis.

Treatment of Periodontal Disease:

Treatment of periodontal disease typically begins with scaling and root planing, or what some people call a "deep cleaning". Due to deep pockets around the teeth following bone loss, a normal cleaning cannot effectively remove plaque and calculus. A deep cleaning involves anesthetizing the areas to be treated, which allows us to clean to the depth of the pocket without discomfort to the patient. Following scaling and root planing, a re-evaluation is done after approximately 6 weeks to determine additional needs. In more severe cases, scaling and root planing simply cannot achieve a result that is maintainable. Our ultimate goal is to stabilize and stop the progression of disease, and to create an oral environment that is maintainable with normal maintenance (regular cleaning) visits. In order to accomplish this, the following treatments may be necessary:

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